Healthcare Provider Details

I. General information

NPI: 1548873870
Provider Name (Legal Business Name): ANDREA MARIA MASIELLO FNP-C, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/03/2023
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

69 W CHURCH ST
FAIRPORT NY
14450-2105
US

V. Phone/Fax

Practice location:
  • Phone: 585-503-0097
  • Fax:
Mailing address:
  • Phone: 585-503-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number346517
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: